Paeds Cases · fetal-neonatal-and-perinatal
Neonatal gastro-oesophageal reflux and aspiration — clinical case
Clinical case of a thriving preterm infant with posseting and feed-related desaturations, illustrating the conservative-first management, restraint with acid suppression, and the distinction between physiologic reflux and disease.
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RACP DCEMRCPCH ClinicalABP General Pediatrics
Prompt
A 33-week preterm infant, now 18 days old and exclusively tube-fed, has frequent small effortless posseting within an hour of each bolus feed and three to four desaturations to 88 to 90 percent in the same window that resolve with gentle stimulation. Weight is tracking the 10th centile, the abdomen is soft, the vomit is never bile-stained, and there are no red flags on examination. The nursing staff have requested a proton-pump inhibitor for reflux.
Case summary
This thriving preterm infant has effortless posseting and feed-related desaturations with no red flags — a textbook picture of physiologic gastro-oesophageal reflux rather than disease. The clinical skill on display is restraint: resisting the request for a proton-pump inhibitor, confirming that this is physiologic reflux, and managing conservatively while understanding that the feed-related desaturations are most likely coincidental rather than causal. [1]
References3ShowHide
- [1]Rosen R, Vandenplas Y, Singendonk M, et al Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr, 2018.PMID 29470322
- [2]Tighe MP, Andrews E, Liddicoat I, et al. Pharmacological treatment of gastro-oesophageal reflux in children. Cochrane Database Syst Rev, 2023.PMID 37635269
- [3]Eichenwald EC Diagnosis and Management of Gastroesophageal Reflux in Preterm Infants. Pediatrics, 2018.PMID 29915158